Not a happy birthday

When Lynsey* went into hospital to have her baby, she expected to leave a mother. After many hours of difficult labour and a wholly unexpected turn of events, she exited the building not only a mother but a victim of assault. Like thousands of other women, she was violated in the worst possible way when at her most vulnerable. What she had experienced was birth rape, and she would never be the same.

The idea of being raped while giving birth is difficult to imagine. In most people’s minds, rape means forced sexual intercourse where a penis is inserted, forcefully and without consent, into another person’s body. Some broaden that definition to include objects as well as body parts. But still, we often picture rape as an act of demented sexual anger and misogyny, perpetuated by sick individuals. In fact, rape is more frequently a display of power and control, a way to subjugate another human being. And it doesn’t just happen in dark alleyways, bedrooms tinged with the smell of alcohol and ‘mixed signals’, or in war zones. It can (and does) happen in some of the most respected and revered institutions in the land – hospitals.

A woman who is raped while giving birth does not experience the assault in a way that fits neatly within the typical definitions we hold true in civilised society. A penis is usually nowhere to be found in the story and the perpetrator may not even possess one. But fingers, hands, suction cups, forceps, needles and scissors… these are the tools of birth rape and they are wielded with as much force and as little consent as if a stranger grabbed a passer-by off the street and tied her up before having his way with her. Women are slapped, told to shut up, stop making noise and a nuisance of themselves, that they deserve this, that they shouldn’t have opened their legs nine months ago if they didn’t want to open them now. They are threatened, intimidated and bullied into submitting to procedures they do not need and interventions they do not want. Some are physically restrained from moving, their legs held open or their stomachs pushed on.

Desperate for the attack to stop, she lashed out and tried to kick the woman away, only for another midwife to firmly hold her feet down

Lynsey, whom I met on an internet support group for birth trauma survivors, tells of how her midwife rammed a hand up into her vagina to manually dilate her cervix (a procedure that is very painful and ill-advised) because she had been up all night and was “tired of how long this was taking”. Even as Lynsey squirmed and screamed “No! Get off of me!” while dealing with the excruciating pain of another monster contraction, she was laughed at and mocked for being a “bigger baby than the one she was trying to push out”. Lynsey looked to her partner for support, but he just held her hand and whispered soothing words as the midwife continued to assault her genitals. Desperate for the attack to stop, she lashed out and tried to kick the woman away, only for another midwife to firmly hold her feet down. When the procedure didn’t speed things up satisfactorily enough for the staff on shift that night, Lynsey’s labour was declared as ‘failure to progress’ and she was rushed into theatre for what she feels was an unnecessary caesarean.

Lynsey said of the experience: “When the midwife ripped off her blood-stained glove after she had finished with me and threw it on the floor in disgust, I felt as if she had completely discarded my dignity as well. I went numb, unable to speak for the remainder of the labour, remembering the disgust in her eyes when my body and my behaviour didn’t match her expectations. To then be cut open felt like punishment for not being a ‘good girl’ and complying.”

Violating and abusing patients into submission to make things simpler for health care professionals is not an acceptable excuse, no matter how many hours they’ve been on shift

As a result of this trauma, Lynsey suffered from post traumatic stress disorder and tokophobia (fear of childbirth). She became deeply depressed, had nightmares and flashbacks, trouble bonding with her son, and her marriage nearly broke down because her husband couldn’t acknowledge that she was raped by the midwife and he had stood by while it happened. He begged her to stop calling it rape and to let it go, get on with her life. As so many new mothers can attest, any anger, sadness or disappointment expressed about the birth is usually swept under the rug. Everyone says: “Yes, but it’s all in the past now. You have a healthy baby and that’s all that matters.” As if the woman who endured the birthing experience was merely a passive observer, the emotionless vehicle through which the baby arrived.

After two years of therapy, medication and joining a support group with other women who have experienced severe trauma and mistreatment during childbirth, Lynsey is finally starting to heal but will never forget the humiliation and degradation she suffered at the hands of a medical team hell-bent on forcing her to submit. Every time she looks at her caesarean scar she remembers how frightened, violated and alone she felt. But she’s tired of keeping quiet and wants other women to know, especially those who campaign to end violence against women, that rape can and does happen to women giving birth and that it’s no less serious than those crimes fitting the more accepted definition. More and more women are coming forward and sharing their stories but it’s still a tiny proportion of those who have been assaulted. Even more so than ‘regular’ rape victims, these women feel they won’t be believed and will be ridiculed. Going up against a rapist is scary enough, but when your rapist is a well-respected doctor or matronly midwife at an NHS hospital run by the British government, the odds of a successful complaint or criminal prosecution seem remote and insignificant.

So how in the world did we get to this point, where scores of women are being treated like slabs of meat on a butcher’s table or cogs in the machinery of a conveyor belt? We believe that western medicine is so advanced and our technology so incredible that we rarely stop to think about the effects they have on biological processes and people themselves. Some things are not meant to be tampered with too much and childbirth may be one of them. While we have been conditioned to believe that hospitals are the safest places to birth babies, studies show that the risks of infection are higher, maternal satisfaction with the experience is lower and maternal and infant mortality rates are the same or worse for low-risk mothers delivering in hospital as for those babies born at home to low-risk mothers.

Women who experience rape or abuse in the maternity ward often plan for caesareans (which have their own, very real risks), terrified of going through the pain and degradation again, or forgoing hospitals altogether and birth their babies at home

Many are quick to state that without modern technology, women would be dying in droves like they did ‘in the old days’. While it is true that many women died during childbirth in decades and centuries past, there is more than just the absence of technology to account for that. Poor diet, the prevalence of infectious diseases and conditions such as rickets (a calcium and vitamin D deficiency) which can result in pelvic deformity, unhygienic living conditions, contaminated water, lack of antibiotics to treat infections, lack of blood supplies for successful transfusions and poorly informed birth attendants were more often than not the cause of death, not a lack of epidurals and electric foetal heart monitors.

The incidence of babies being too big to pass through a pelvis, getting truly stuck or being in such distress as to warrant a caesarean is much smaller than current advice would have us believe. At the moment, the caesarean rate is the highest it has ever been in the UK, at 23%. Considering that it was under 3% in the 1950s and 12% by 1991, such a huge leap in the past 15 years is alarming. While caesareans are a necessary means of delivery for the small percentage of births that truly require them (the World Health Organization and NICE guidelines recommend a rate of no more than 10-15% in any country) and should be celebrated when used appropriately and in the right circumstances, too many are performed for reasons the medical professionals are not keen to admit – lack of space and beds, lack of staff and resources to support a woman through a vaginal birth and the rising concern with covering themselves from a legal standpoint. When the slightest drop in heart rate or a long labour sends the surgeon scrambling for a knife, is that progress? Or has the medicalisation of birth gone too far?

Successfully supporting a woman through labour requires care, patience, empathy, physical and emotional support, an investment of time and an intimacy between caregiver and labouring woman. As a recent report reveals, maternity wards all across the UK are ill-equipped to provide those things and, in many cases, aren’t even providing the basics. Understaffed wards where the existing staff are overworked and stretched too thin, a shortage of space and resources and lack of continuity of care are some of the principal reasons for their failures. Some would also say that a male-dominated obstetric mindset of controlling and ‘curing’ the patients (even though pregnancy is not a disease) and running wards like businesses contribute to the lack of personable care. These are not easily solved issues, as none of the problems within the NHS are, but women giving birth are the ones paying the price. Violating and abusing patients into submission to make things simpler or quicker for health care professionals is not an acceptable excuse, no matter how many hours they’ve been on shift or how much easier it would be if they didn’t have to invest so much time and effort into being supportive and kind instead of efficient and cruel.

By recognising birth rape as institutionalised violence and a feminist issue worthy of address, we can work towards minimising and then ending it

Until women take back the power of birth for themselves, I’m afraid that incidences like Lynsey’s will continue to rise and the culture of birth rape will go virtually unnoticed and unpunished, leaving damaged mothers in its wake. Assault against women is something we all strive to end. By recognising birth rape as institutionalised violence and a feminist issue worthy of address, we can work towards minimising and then ending it. As with anything, education and self-awareness are the keys. Understanding all of the information and choices in birth, not just what’s laid out in an NHS leaflet or spouted by a GP as fact, is paramount if women are to gain control of their bodily autonomy again. So if your doctor says “trust me”, remind him or her that trust has to be earned and is not an inherent right derived from their title.

For too long now, pregnancy and birth have been under the control of a patriarchy that persists in treating women like children and birth like a well-oiled machine where only the end product matters, not the journey of its creation. As a result of this, two separate backlashes are forming. Those who experienced trauma or rape in their first births are either electing for planned caesareans (which have their own, very real risks), terrified of going through the pain and degradation again, or forgoing hospitals altogether and birthing their babies at home, sometimes even unassisted by any professionals (called ‘unassisted childbirth’ or UC). While homebirth is a perfectly safe option and one that I fully support (I’m having one myself this autumn), I know that many women are not comfortable with the idea and instead of forcing them into something they don’t want, we should be striving to make all birthing environments, whether at home or in hospital, both safer and more peaceful and empowering.